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Copyright © 2018 by The City of Los Angeles. All rights reserved. OPEN ENROLLMENT 2019 Dental Benefits
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OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Mar 18, 2020

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Page 1: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Copyright © 2018 by The City of Los Angeles. All rights reserved.

OPEN ENROLLMENT 2019

Dental Benefits

Page 2: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Delta Dental Dental options for the City of LA employees

Page 3: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

City of LA offers 3 great choices

Your Delta Dental Plan Choices

Preventive PPO DeltaCare® USA

Page 4: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Delta Dental PPOSM

Page 5: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Your smile is covered Delta Dental PPOSM

You can visit any

licensed dentist

Visit a PPO dentist to

save the most.

You won’t be charged

more than your

expected share of the

bill.

Page 6: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists

In-Network Out-of-Network

Delta Dental PPOSM

Delta Dental

Premier®

Non-Delta Dental dentist

Dentist charges $1,200 $1,200 $1,200

Plan allowance $700 $900 $900

Your plan pays $560 $450 $450

You pay $140 $450 $750

This is for illustrative purposes only. Assume no maximums or deductibles apply.

Page 7: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Delta Dental PPOSM

PPO dentist Non-PPO dentist

Annual Maximums & Deductibles

None None

Diagnostic & Preventive Cleanings, exams, x-rays*

Plan pays 100%

Plan pays 100%

Basic Services Fillings, root canals, gum treatments, oral surgery

No coverage No coverage

Major Services Crowns, bridges, partials, dentures, implants, orthodontics

No coverage No coverage

Delta Dental PREVENTIVE Plan Covered Services/Copayments

Page 8: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Delta Dental PPOSM

PPO dentist Non-PPO dentist

Diagnostic & Preventive Cleanings, exams, x-rays*

Plan pays 100%

Plan pays 80%

Basic Services Fillings, root canals, gum treatments, oral surgery

Plan pays 80%

Plan pays 80%

Cast restorations Crowns, inlays, onlays

Plan pays 80%

Plan pays 50%

Major Services partials, dentures, implants, orthodontics

Plan pays 50%

Plan pays 50%

Delta Dental PPO Plan Covered Services/Copayments

Page 9: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Delta Dental PPOSM

PPO dentist Non-PPO dentist

Annual Deductible *waived on D&P services

$25 per person $75per family

$50 per person $150 per family

Annual Maximum *D&P services do not apply

$1,500 per person $1,500 per person

Orthodontic lifetime maximum

$1,500 per person $1,500 per person

Delta Dental PPO Plan Deductibles and Maximums

Page 10: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Cost Estimator Budget for dental expenses with personalized estimates

Personalized. Estimates are based on

your benefits, including maximums and

deductibles.

Insightful. Compare the cost of the

same procedure at different dentists.

Economical. See how choosing an in-

network dentist can help you save.

Available on desktop and mobile

Page 11: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

It’s easy to plan for dental expenses

Pre-treatment estimate

Ask your dentist for an

estimate Dentist sends details to

Delta Dental You and your dentist receive a cost estimate

Page 12: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Your smile is covered Delta Dental PPOSM

You don’t need an ID card to

check in.

We’ll coordinate dual coverage.

Create an Online Services

account to check your benefits

and claims online.

Page 13: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

DeltaCare® USA

Page 14: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Choose a primary care dentist from the

DeltaCare USA network

Visit your primary care dentist to receive

benefits

Pay set copayment (if any) for covered

procedures

No deductibles or maximums

Adult & Children Orthodontic Coverage

Comprehensive coverage DeltaCare® USA: a prepaid, fixed copayment plan

Page 15: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

If you need specialty

care, your primary care

dentist will refer you

Your primary care dentist

requests authorization

for specialty services

Plan includes out-of-

network coverage for

emergencies

Specialty and emergency coverage DeltaCare® USA

Page 16: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

How DeltaCare® USA works Getting dental care is easy

Choose a primary care dentist online or by phone

Make an appointment

Visit the dentist

Pay your copayment (if any)

1 2

3

4

Page 17: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

What’s covered? Your DeltaCare® USA plan

Deductibles and maximums

None

Diagnostic and preventive services

Cleanings $0

Exams $0

Bitewing x-rays $0

Basic Services

Amalgam fillings $0

Composite fillings-anterior $0 - $75

Extractions $45 - $75

Root Canals $45 - $205

Root Planing & Scaling $0 - $90

Major Services

Crown $55 - $195

Partials/dentures $80 - $170

Implant Not covered

Page 18: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

All about braces DeltaCare® USA

Orthodontic coverage for children

and adults

All phases of orthodontic treatment

are covered

Pre- and post- records

Tooth extractions

Coverage for in-progress treatment

Page 19: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

What’s covered? (continued) Your DeltaCare® USA plan

Comprehensive orthodontic treatment

Children

$1,000 copayment

$200 pre- treatment cost

$70 post-treatments cost

$275 retention (retainers)

Adults

$1,350 copayment

$200 pre- treatment cost

$70 post-treatments cost

$275 retention (retainers)

Page 20: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Compare Dental Plans

Delta Dental

Preventive

DeltaCare® USA

DHMO

Delta Dental

PPO

Features a network of providers Yes Yes Yes

Offers flexibility to use any dentist Yes No Yes

Covers preventive care Yes Yes Yes

Covers basic and major services No Yes Yes

Covers implants Yes No No

Calendar year deductible No No Yes

Annual maximum benefit No No Yes

Emergency care outside provider

network

No Yes – up to $100

per incident

Yes

Orthodontic Coverage for children No Yes Yes

Orthodontic Coverage for Adults No Yes No

Page 21: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

MEMBER RESOURCES

Page 22: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Check your benefits information online

Search for a network dentist in your area

Check your plan details: eligibility,

covered services and level of benefits.

Look up claim statements for recent

dental visits.

View or print your ID card.

Estimate the cost of your next procedure.

Submit questions to Customer Service.

Check out the website

Page 23: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Find a network dentist Use the online dentist search

1. Go to deltadentalins.com

and log in.

2. Select Find a Dentist.

3. Choose your Plan PPO or

DeltaCare® USA

4. Search by name, address,

landmark, city or ZIP

code.

5. Get a map and driving

directions.

Page 24: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Go mobile Visit the mobile-optimized site or download the app

Find a dentist

Coverage details

Electronic ID card

Cost estimator

Musical timer

Mobile-optimized site ✓ ✓ ✓ ✓ Delta Dental app ✓ ✓ ✓ ✓ ✓

Visit the mobile-optimized site on your smartphone at deltadentalins.com, or download the Delta Dental app from Google Play or the App Store.

Page 25: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Learn about dental health

• 100+ articles on everything from

acid reflux to x-rays

• Short videos

• Tooth-friendly recipes

• Quizzes to assess your dental risks

Online wellness resources

mysmileway.com

Page 26: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

Get help by phone or online

Call us toll-free

PPO/Preventive – 800-765-6003

DCUSA – 800-422-4234

Speak to a Customer Service

representative Monday through Friday,

5 am to 5 pm Pacific time

Ask online: Go to deltadentalins.com >

Contact Us > Delta Dental of California

> Customer Service Form

Contact Customer Service

Page 27: OPEN ENROLLMENT 2019 · 2018-10-27 · Choose PPO to save Crown Claim example: 80% In-Network PPO dentists 50% Out-of-Network dentists In-Network Out-of-Network Delta Dental PPOSM

We’re pleased to take your questions

Thank you for your time


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